AF Ablation Strategies and Controversies in 2025: Learn From the Experts (non-ACE)-AF Ablation Strategies and Controversies in 2025: Learn From the Experts (non-ACE)

Video Transcription

Video Summary

In this discussion session, a panel of experts, including Laurent Max from the Montreal Heart Institute and Susan Eisenberg from the United States, gathered to explore various aspects of atrial fibrillation (AF) ablation procedures, particularly with the use of pulmonary vein isolation (PVI) and pulsed field ablation (PFA) technologies. Panelists included renowned specialists from diverse geographic regions such as Moussa Mansour from Boston, Melanie Gunawardene from Germany, Andrea Natale from the USA, and Pierre Jais from France. They discussed procedural workflows, the impact of different energy modalities, and strategies to enhance safety and success rates in AF ablation.<br /><br />The conversation delved into specifics regarding the planning and procedural workflow differences when using standard technologies versus PFA, which is typically limited to pulmonary veins in certain jurisdictions. They examined pre-procedural strategies, including managing anesthesia and checking renal functions, which can impact the procedural approach. The panelists also provided insights into how they handle unexpected arrhythmias encountered during procedures and discussed how different mapping and ablation strategies can be applied.<br /><br />Safety concerns, such as managing coronary spasms induced by PFA and the importance of tools like intracardiac echocardiography (ICE), were addressed. The experts emphasized the significant advantages of PFA, notably its safety profile, with no reports of pulmonary vein stenosis or atrio-esophageal fistulas and its superior lesion durability, suggesting its potential to revolutionize AF treatment protocols. The discussion concluded while touching upon the integration of left atrial appendage closure during AF ablation and considerations for anticoagulation management post-ablation.

Keywords

atrial fibrillation

AF ablation

pulmonary vein isolation

pulsed field ablation

Laurent Max

Susan Eisenberg

procedural workflows

safety concerns

intracardiac echocardiography

anticoagulation management